Oncotype Testing Results

Cherry02031978

Hi everyone! I had a lumpectomy on Nov. 1 and my tumor was sent off on nov. 14 to do the Oncotype test. I'm 37, have IDC, tumor size 2.2, grade 2, lymph node negative and clear margins. Has anyone who has thought that their onco score was going to come back high actually came back low? My tumor is er/pr positive, her 2 negative. I'm just hoping and praying it is low, but my oncologist thinks it will fall in the intermediate.

bluepearl

Grade 2's can come back low....even women with lymph node involvement can still come back low while grade 1's can come back high.

Misty879

Mine was a 24 and I was diagnosed with IDC in June, stage 1, grade 2, er+ pr- her2- and tumor size was 1.4cm with no lymph node involvement or LVI. My doctor said my cancer's biology is just intermediate all the way around. That's the hardest thing because there is so little research about what really benefits intermediate people like me. My doctor said he was ok with me not doing chemo because of all
the other factors in my situation, but he would of given it to me if I asked because of the score. There's no real research on what score cut off in the intermediate range benefits from
Chemo and which doesn't. I opted to not do chemo.

Variable

I think once you get a BC you did not expect to get, every test result you wait for in your mind is the worst case scenario. I think I read only 15% of Oncotype scores come back in the low range. My diagnosis was very similar to yours and my score was a 19 (just within the intermediate range). My MO said he would not deny chemo if I wanted it (for an extra 3% of recurrence protection), but he did not think the risks would be worth the benefit. When you look at the chart of your results and benefits of treatment when compared to the low risk group, your treatment decisions will become clearer! Wishing you a low score and calm while you wait

BarredOwl

The following relates to node-negative (N0) groups only and various reported distributions of Recurrence Scores.

While the TAILORx study reported only 15.9% of patients with a "Low Risk" Recurrence Score, it is important to understand that TAILORx uses non-standard, investigational recurrence score ranges. Thus, the reported 15.9% included only those with a Recurrence Score of 0 to 10.

Sparano (2015): http://www.nejm.org/doi/pdf/10.1056/NEJMoa1510764

"A total of 1629 patients (1626 of whom were eligible [15.9% of the total eligible population]) had a recurrence score of 0 to 10 (indicating low risk), 6907 (6897 of whom were eligible [67.3% of the total eligible population]) had a score of 11 to 25 (indicating midrange risk), and 1736 (1730 of whom were eligible [16.9% of the total eligible population]) had a score of 26 or higher (indicating high risk)."

In contrast, the original validation studies (Paik (2004) and Paik (2006)) featured in the node-negative (N0) report each reported a slight majority of patients with standard low risk recurrence scores (< 18):

Paik (2004): http://www.nejm.org/doi/pdf/10.1056/NEJMoa041588

Per Table 1, you can see that 51% of patients had a "Low Risk" Recurrence Score (< 18):

Using a different patient cohort, Paik (2006) also reported a slight majority (54.2%) with a standard "Low Risk" Recurrence Score (< 18):

Paik (2006): http://ascopubs.org/doi/pdf/10.1200/JCO.2005.04.7985

"There were 353 patients (54.2%) in the low-risk group (RS < 18), 134 patients (20.6%) in the intermediate-risk group (RS 18 to 30), and 164 patients (25.2%) in the high-risk group (RS ⩾ 31)."

A recent large, retrospective observational study also reported a slight majority (55%) with a standard "Low Risk" Recurrence Score (< 18).

Petkov (2016): http://www.nature.com/articles/npjbcancer201617

"Recurrence Score result and breast-cancer-specific mortality (Node-negative)

Of 38,568 patients in the prespecified primary analysis cohort, 21,023 (55%) had Recurrence Score results <18, 14,494 (38%) had results 18–30, and 3,051 (8%) had results ⩾31."

BarredOwl

M0221

I was diagnosed with IDC 9/29/16. One month ago I had a bilateral mastectomy with bilateral sentinel node biopsies. I was stage 2, grade 3, 2.6cm, node negative, Her2-, Estrogen+ 90%, Progesterone+ 70%, oncotype DX was 24 and I am 48 years old. I find out about chemo in 3 days. Waiting for the score to come back was difficult, now the wait for my appt with the MO seems like it is forever away. Hang in there! Keep us posted when you hear.

TexasTaTa58

I have very mixed feelings about the Oncotype test. I would have done everything the same if I had not had it done. For me, it just added more stress and confusion, without benefit of useful information, plus added another $800 expense. In August 2016, I was diagnosed with Stage 1a IDC, right breast,1.5 cm tumor excised with lumpectomy, Estrogen and Progesterone positive, HER2 negative with clear margins and no nodes involvement. Oncotype score was 18 - right on the low-intermediate line. I elected to NOT do chemo as there is no evidence supporting the benefits outweigh the risks. I was found to be ideal candidate for accelerated 16-session radiation which I completed in October. Have been on Arimidex 3 weeks.

Meow13

Also oncodx is based on tamoxifen not AI drugs very different; the risks aren't that compelling to me neither is the statistical sample size. I would have liked to have seen the components that put me in the number I received. Ive seen the curve fitting equations but not my specific components. The only thing adding risk I could tell was my pr being less than 1 percent however er was 95 percent. My grade was just barely 2 on the Nottingham scale mitotic rate a 1. I feel the AI hormone therapy was effective in my case but not without some health damage, arthritis in spine and neck. We need better safer more effective treatments. I get so mad when I hear the medical community say how far we've progressed in BC treatment.

I get even madder when I see people dying from BC, unacceptable.

Laurenann78

I was 37 at dx but I had Mammaprint done because my MO wouldn't do Oncotype due to my age. I was fully prepared to be high risk but actually came back low risk. I opted for no chemo and am doing RADS then Tamoxifen. You can ask for Mammaprint to be sent if you want a second option to give guidance on your decision.

edwards750

My Oncotype score came back@11. I had a lumpectomy and 33 Rads treatments. I had IDC Stage 1b, Grade1. I was truly blessed. I hit the 5 year milestone last August. You can do this. We are all proof you can. It's not the death sentence itused to be be. Keep the faith.

Diane

Positive2strong

I do not want chemo.

ok, Here I am again, so down and very confused. I had the mamma print and my Dr appt today where he recommended chemo than radiation. My nodes were clear, clear margins and 1.5 tumor stage 1a originally I thought grade 1 now he says grade 2/3 but my tests after surgery was the same as biopsy.

I am going to get out my biopsy report and reread.

The mamma print which I don't understand luminal type +0.644 HER 2type -0.564 basal type 0.609

Ffpe result -0.592. High risk

So 5 year 22% reacurrance

He said that by having chemo it reduce reaccurance by 10%

So is anyone out there in my situation. I am seeing the breast cancer doctor on the 15 of Dec as each time I was to see her I got this doctor. He is oncologist.

I want to just do radiation..... any help is appreciated

Meow13

My advice to people is to go with your instinct. I didn't do chemo for recurrence and Im ok. I had very strong feeling against the recommendation. If you feel more secure doing it for go for it. Your instincts maybe be just as reasonable as the oncodx. Whether a 23% chance versa 10% go with what you feel is the right treatment. I cant tell you how many friends felt cheated by getting a low oncodx number just to have cancer reoccur. Talk about needing a crystal ball. I have heard other wish they had done chemo. It might of helped but no one knows.

KBeee

You might want to get a few opinions; ultimately you will need to decide if the % benefit of chemo is worth the side effects and risks. Some people want a 30% benefit; others will do it for a 2% benefit. Age, other medical issues, and expected years you want to live all play into the decision. High risk does mean that the genetic characteristics of the tumor make it more likely to metastasize. That is what chemo is trying to prevent These are hard decisions. Best wishes.

Icantri

Well said KBee.

And I agree with Meow about trusting instinct. I won't go into specifics but I chose a mastectomy even though I felt the docs thought I should do lumpectomy. MO told me in followup visit that I had made the right choice (I won't bore you with why).

Positive2 I think if you have strong feelings about your treatment (emphasis being it is YOUR treatment) you should follow your heart. Sounds like you are keeping an open mind too, which is good but if they aren't convincing you, it is ok to disagree. They are making recommendations based on the data they have from case studies of people with similar diagnosis/characteristics. Recommendations that would give you the best chance but no guarantee. You are an individual and as long as you won't beat yourself up too bad later if it recurs, I say do what feels right to you. Some people choose no treatment at all. Everyone is different. You are an individual, not a number. A special individual. Do what you will be most comfortable with.

Icantri

also, I forgot to mention that my situation is very similar to yours Positive2, I will find out next week what my oncotype results are. my largesttumor size was 1.2 and my grade is "1 or 2" so who knows.

I originally thought I would do chemo if I fell in the intermediate group but lately I am thinking probably only if they say it is really aggressive. But i don't see how it could change so drastically from grade 1(or 2) all the way to a 3. Especially since I had my surgery only a month after biopsy.

poopysheep

Icantri - you and I have basically the exact same stats.. had my surgery almost exactly a month post diagnosis ... my onco score was 15 and they reran the pathology on the tumour and it still came back grade 1 (mitosis is also a 1). I wasn't even given chemo as an option.

Good luck - it's all sort of confusing and I really don't think there is one right answer for everyone

Positive2strong

I have no idea what to do I don't want chemo all I can figure is that Chemo lowers my risk of reacurrance by 10% I am 66 and now getting another opinion. I think I have similar Dx but my mamma print ffpe was -0.592

Keep me informed on your progress

Positiv

sballan

Did you ever get the results of the Oncotype test? My Oncologist wouldn't even give a recommendation about chemo until he had the results. I was pretty much thinking that I would definitely have to have chemo because even though my tumor was small, 1 node tested positive. The test results came back yesterday and it was 10! Everything I have been reading says that 1b cancer ER+/HR+ HER2- and chemo is not effective if one has a score lower than even 18. I have not discussed with my oncologist, but I am thinking they will not recommend chemo now. I am so doing a happy dance. I think though in your situation, since you are ER+/PR- drugs may not be as effective as with someone with strong ER/PR +. So that is probably why your oncologist is recommending it. Did you get a second opinion? I am going to see another oncologist just to make sure. Ultimately it is your decision. Good luck.

Meow13

positive, you must be past the time to do chemo if you got your dx in August.

Smurfette26

I was told the optimum time to start chemo was within 6 weeks of surgery.

simsoka

Hi Positive2strong, I had a grade 2, 7mm tumor, ER+/PR-/HER2-. My oncotype results showed the tumor was aggressive with a 34% chance of recurrence. One oncologist said she would not recommend chemo; she didn't even recommend having the oncotype test because the tumor was small. The other oncologist ordered the test and wanted to get going with chemo asap. I opted out. I'm scared, but like you, I feel strongly about not doing it. So difficult to know what to do. Just wanted to let you know I'm there with you!

Are you having the oncotype test done in addition to mammaprint? I'd be curious to know your results.

wendymk2016

My IDC tumor is about 2mm. Grade 2/3, ER >90% and PR-, HER2-. Ki67 10%.

All the MO I saw so far refused to order oncotype DX. Their reason is tumor is too small, and the result is not reliable based on the tumor size and should not be used to make decision about treatment plan.

So, I have no idea and since I did the mastectomy, the only therapy I am taking is Tamoxifen pill.

simsoka

wendymk2016, From what I understand, the standard of care is to not do the Oncotype test for tumors 5mm and smaller. My oncologist also said the clinical trial for the Oncotype test didn't include tumors my size (7mm), which was why she too advised against doing having it done.

BarredOwl

Hi Simsoka:

Re: "My oncologist also said the clinical trial for the Oncotype test didn't include tumors my size (7mm) . . "

I am not sure what "clinical trial" your MO was referring. While such tumors may not be quite as well represented as larger tumors, there are clinical trials of OncotypeDX for invasive disease which did include tumors less than or equal to 1 cm.

Importantly, among these are the two clinical validation studies featured in the node-negative (N0) Oncotype report that are used to provide "prognostic" and (when applicable) "predictive" information to patients:

(1) Paik (2004), the study which is featured in the first section of the node-negative (N0) reports and which is used to provide prognostic information about 10-year distant recurrence risk with 5 years of tamoxifen included 109 patients with tumors less than or equal to 1 cm. As noted therein:

Paik (2004): http://www.nejm.org/doi/pdf/10.1056/NEJMoa041588

"Moreover, not all patients with small tumors (109 patients with a tumor 1 cm in diameter or smaller) were at low risk; the recurrence score identified 44 of those patients as having an intermediate or high risk and a 15 to 20 percent risk of distant recurrence at 10 years."

(2) Paik (2006), the study which is featured in the second section of th node-negative (N0) reports and which provides information regarding potential benefit of added chemotherapy according to Recurrence Score also included patients with tumors less than or equal to 1 cm:

Paik (2006): http://ascopubs.org/doi/full/10.1200/jco.2005.04.7985

Figure 1B shows the relationship between Tumor Size (X-axis) and Recurrence Score (0 to 100) (Y-axis). By my reading, this study included 110 tumors less than or equal to 1 centimeter in size (see far left, n = 110).

[Edited to add:

Note that the NCCN guidelines (Version 2.2016) do not mandate the Oncotype ("21-gene test") test in any group of patients. For node-negative (N0) ductal, lobular, mixed or metaplastic disease that is hormone receptor-positive and HER2-negative, they provide:

For "Tumor >0.5 cm": "Consider 21-gene RT-PCR assay" [i.e., the OncotypeDX test for invasive disease]

Thus, the guidelines still provide for some decisions regarding the addition of adjuvant chemotherapy to endocrine therapy to be made on the basis of standard clinico-pathologic features of disease.]

BarredOwl

Positive2strong

Simsoka,

They have said nothing about onotype, I thought we get one or the other.

I think I have to do the chemo, My MO didn't seem like there was a fast rule to timing. My surgery was Oct 10, 2016

BarredOwl

Hi Positive2strong:

There is some evidence regarding preferred timing for initiation of chemotherapy. Please take steps to initiate treatment at this time if that is your final decision, because unnecessary delays are undesirable.

For example, the results of a large study regarding time to chemotherapy ("TTC") in the adjuvant setting (where chemotherapy is administered post-surgery) was published in 2016:

Chavez-MacGregor (2016): "Delayed Initiation of Adjuvant Chemotherapy Among Patients With Breast Cancer"

(Full-length article behind paywall)

Abstract of March 2016 article: http://oncology.jamanetwork.com/article.aspx?articleid=2474437

"Importance Adjuvant chemotherapy improves outcomes of patients with breast cancer. However, the optimal timing of chemotherapy initiation is unknown. Delayed administration can decrease the benefit of cytotoxic systemic therapies.

Objective To identify the determinants in delayed chemotherapy initiation and to determine the relationship between time to chemotherapy (TTC) and outcome according to breast cancer subtype. We hypothesized that prolonged TTC would be associated with adverse outcomes.

Design, Setting, and Participants In an observational, population-based investigation using data from the California Cancer Registry, we studied a total of 24 843 patients with stage I to III invasive breast cancer diagnosed between January 1, 2005, and December 31, 2010, and treated with adjuvant chemotherapy. Data analysis was performed between August 2014 and August 2015.

Main Outcomes and Measures Time to chemotherapy was defined as the number of days between surgery and the first dose of chemotherapy, and delayed TTC was defined as 91 or more days from surgery to the first dose of adjuvant chemotherapy. We evaluated overall survival and breast cancer–specific survival. Logistic regression and Cox proportional hazard models were used.

Results In all, 24 843 patients were included. Median age at diagnosis was 53 years, and median was TTC was 46 days. Factors associated with delays in TTC included low socioeconomic status, breast reconstruction, nonprivate insurance, and Hispanic ethnicity or non-Hispanic black race. Compared with patients receiving chemotherapy within 31 days from surgery, there was no evidence of adverse outcomes among those with TTC of 31 to 60 or 60 to 90 days. Patients treated 91 or more days from surgery experienced worse overall survival (hazard ratio [HR], 1.34; 95% CI, 1.15-1.57) and worse breast cancer–specific survival (HR, 1.27; 95% CI, 1.05-1.53). In a subgroup analysis according to subtype, longer TTC caused patients with triple-negative breast cancer to have worse overall survival (HR, 1.53; 95% CI, 1.17-2.00) and worse breast cancer–specific survival (HR, 1.53; 95% CI 1.17-2.07).

Conclusions and Relevance For patients with breast cancer, adverse outcomes are associated with delaying initiation of adjuvant chemotherapy 91 or more days. Delayed TTC was particularly detrimental among patients with triple-negative breast cancer. The determinants of delays in chemotherapy initiation appeared to be sociodemographic, and clinicians should provide timelier care to all patients."

Commentary (behind paywall): http://oncology.jamanetwork.com/article.aspx?articleid=2474434

BC.org summary: http://www.breastcancer.org/research-news/timely-treatment-improves-survival

Limitations: Most studies in this area are retrospective and have various limitations. In addition, the results of various studies in this area are not consistent with each other in all aspects, and there are some important differences between sub-groups (e.g., triple-negative). Thus, regarding time to chemotherapy, patients should always seek current, case-specific expert professional advice, to ensure the complete body of evidence, including the most recent and reliable data that is applicable to their particular situation and diagnosis, is considered.

Patients experiencing larger delays should not decline treatment, but should seek case-specific expert advice regarding potential impact.

BarredOwl

Jcolby

My tumor was 20 mm, grade 3, stage 2, ER+, PR+, HER -, Oncotype dx score was 29. I only did 19 radiation treatments, I declined chemotherapy. I will do hormone therapy for 10 years. I've always felt confident in the care I received at Mayo, but when reading that others on this site are getting far more aggressive treatment for tumors that are smaller, lower grade, and lower Oncotype dx score than mine, it makes me question that I did the right thing. I guess time will tell.

Meow13

Jcolby, my oncodx was 34 and I did not do chemo. No regrets 5 years NED.

I think hormone therapy is proving to be very effective especially AI drugs in er+ and pr- cancers.

Jcolby

Meow, it certainly does ease my doubts when I hear other's stories. Thanks for taking the time to post.

Utopria

Hello All - My tumour was 3.7cm. Stage II, Grade 2, 2 nodes impacted, ER+/PR+ HER2-

My ocotype came back at 25 and MO said there is a 4% benefit of doing chemo but wanted to do it. Didnt really have a choice. Also did Rads andTamo. The RO was on the fence for the rads, but again MO wanted to err on the side of caution.

But guess what: 2 Years later, IT CAME BACK! Local Recurrence!

In a way I'm glad I did everything I could or else I would have been second guessing my decision.

asunny

hello TexasTaTa58,

Your mentioned the accelerated 16-session radiation, is this 4 weeks radiation therapy? how did you feel about it when you did the therapy?

I have stage 1a IDC, my doctor said I can choose either way (6 weeks OR 4 weeks whole breast radiation

therapy OR 5 days partial external breast), he said the results are almost the same. I am confused, there are some research articles said that 4 weeks therapy may have less side effects compared to 6 weeks... I am still waiting for Oncotype. The first time oncotype failed because of no enough tissues; Now they sent another sample to do the Oncotype test, hope it is low.

thanks!